The Trump administration's move to give deportation officials access to Medicaid data is putting hospitals and states in a bind as they weigh whether to alert immigrant patients that their personal information, including home addresses, could be used in efforts to remove them from the country.
Warning patients could deter them from signing up for a program called Emergency Medicaid, through which the government reimburses hospitals for the cost of emergency treatment for immigrants who are ineligible for standard Medicaid coverage.
But if hospitals don't disclose that the patients' information is shared with federal law enforcement, they might not know that their medical coverage puts them at risk of being located by Immigration and Customs Enforcement (ICE).
"If hospitals tell people that their Emergency Medicaid information will be shared with ICE, it is foreseeable that many immigrants would simply stop getting emergency medical treatment," said Leonardo Cuello, a research professor at Georgetown University's Center for Children and Families. "Half of the Emergency Medicaid cases are for the delivery of U.S. citizen babies. Do we want these mothers avoiding the hospital when they go into labor?"
For more than a decade, hospitals and states have assured patients that their personal information, including their home addresses and immigration status, would not be shared with immigration enforcement officials when they apply for federal healthcare coverage. A 2013 ICE policy memo guaranteed the agency would not use information from health coverage applications for enforcement activities.
But that changed last year, after President Donald Trump returned to the White House and ordered one of the most aggressive immigration crackdowns in recent history. His administration began funneling data from a variety of government agencies to the Department of Homeland Security, including tax information filed with the Internal Revenue Service.
CMS, part of HHS, agreed last spring to give ICE officials direct access to a Medicaid database that includes enrollees' addresses and citizenship status.
Twenty-two states, all but one led by Democratic governors, sued to block the Medicaid data-sharing agreement, which the administration did not formally announce until a federal judge ordered it to do so last summer. The judge ruled in December that in those states, ICE could access information in the Medicaid database only about people in the country unlawfully. KFF Health News contacted more than a dozen hospitals and hospital associations in states and cities that have been targets of ICE sweeps. Many declined to comment on whether they've updated their disclosure policies after the ruling.
Of those that responded, none said they are directly warning patients that their personal information may be shared with ICE when they apply for Medicaid coverage.
"We do not provide legal advice about federal government data-sharing between agencies," Aimee Jordan, a spokesperson for M Health Fairview, a Minneapolis-based hospital system, said in an email to KFF Health News. "We encourage patients with questions about benefits or immigration-related concerns to seek guidance from appropriate state resources and qualified legal counsel."
Information on Applications
Some states' Emergency Medicaid applications specifically ask for a patient's immigration status -- and still assure people that their information will be kept secure and out of the hands of immigration enforcement officials.
For example, as of Feb. 3, California's application still included language advising applicants that their immigration information is "confidential."
"We only use it to see if you qualify for health insurance," states the 44-page form, which the state's Medicaid program, known as Medi-Cal, posted on social media in January.
California Department of Health Care Services spokesperson Anthony Cava said in a statement that the agency, which oversees Medi-Cal, will "ensure that Californians have accurate information on the privacy of their data, including by revising additional publications as necessary."
Until late January, Utah's Medicaid website also claimed its Emergency Medicaid program did not share its information with immigration officials. After KFF Health News contacted the state agency, Kolbi Young, a spokesperson, said Jan. 23 that the language would be taken down immediately. It was removed that day.
Oregon Health & Science University, a hospital system based in Portland, offers immigrant patients a Q&A document developed by the state Medicaid program for those with concerns about how their information might be used. The document does not directly say that Medicaid enrollees' information is shared with ICE officials.
Hospitals rely on Emergency Medicaid to reimburse them for treating people who would qualify for Medicaid if not for their citizenship status -- those in the country illegally and lawfully present immigrants, such as those with a student or work visa. The coverage pays only for emergency medical and pregnancy care. Typically, hospital representatives help patients apply while they are still in the medical facility.
The main Medicaid program, which covers a much broader range of services for over 77 million low-income and disabled people, does not cover people living in the country illegally.
Examining Emergency Medicaid enrollment is the most obvious way, then, for deportation officials to identify immigrants, including those who might not reside in the U.S. lawfully.
HHS spokesperson Rich Danker said in an email that CMS -- which oversees Medicaid, a joint state-federal program -- is sharing data with ICE after the judge's ruling. But he would not answer how the agency is ensuring it is sharing information only on people who are not lawfully present, as the judge required.
With ICE now getting direct access to the personal information of millions of Medicaid enrollees, hospitals -- while "definitely in a tough position" -- should be up-front about the changes, said Sarah Grusin, an attorney at the National Health Law Program, an advocacy group.
"They need to be telling people that the judge has permitted sharing of information, including their address, for people who are not lawfully residing," she said. "Once this information is submitted, you can't protect it from disclosure at this point."
Grusin said she advises families to weigh the importance of seeking medical care against the risk of having their information shared with ICE.
"We want to give candid, honest information even if it means the decision people have to make is really hard," she said.
Those who have previously enrolled in Medicaid or can easily search their address online should assume that immigration officials already have their information, she added.
Emergency Medicaid
Emergency Medicaid coverage was established in the mid-1980s, when a federal law began requiring hospitals to treat and stabilize all patients who show up at their doors with a life-threatening condition.
Federal government spending on Emergency Medicaid accounted for nearly $4 billion in 2023, or about 0.4% of total federal spending on Medicaid.
States send monthly reports to the federal government with detailed information about who enrolls in Medicaid and what services they receive. The judge's ruling in December limited what CMS can share with ICE to only basic information, including addresses, about Medicaid enrollees in the 22 states that sued over the data-sharing arrangement. ICE officials are not supposed to access information about the medical services people receive, per the judge's order.
The judge also prohibited the agency from sharing the data of U.S. citizens or lawfully present immigrants from those states.
Deportation officials have access to personal Medicaid information of all enrollees in the remaining 28 states.
The federal health agency has not clarified how it is ensuring that certain states' information on citizens and legal residents is not shared with ICE. But Medicaid experts say it would be nearly impossible for the agency to separate the data, raising questions about whether the Trump administration is complying with the judge's order.
The Trump administration's efforts to deport immigrants living in the country illegally have had implications on immigrant families seeking care. About a third of adult immigrants reported skipping or postponing healthcare in the past year, according to a KFF/New York Times poll released in November. (KFF is a health information nonprofit that includes KFF Health News.)
Bethany Pray, the chief legal and policy officer at the Colorado Center on Law and Policy, warned that sharing Medicaid data directly with deportation officials will force even tougher decisions upon some families.
"This is very concerning," Pray said. "People should not have to choose between giving birth in a hospital and wondering if that means they risk deportation."
https://www.medpagetoday.com/washington-watch/washington-watch/119775
